The incidence of cardiovascular disease reported amongst HIV infected children ranges from 72% to over 90%. Factors responsible for causing cardiac manifestations include primary HIV disease, immune-mediated reactions, intercurrent infections and drug-toxicity. Direct HIV infection is implicated in the development of pulmonary hypertension, left ventricular dysfunction and
dilated cardiomyopathy which eventually leads to congestive cardiac failure (CCF); this entity is called as HIV associated cardiomyopathy. Other presentations include pericardial effusion seen in advanced stages, the predisposing factors for which include
tuberculosis, CCF, pulmonary infections,
lymphoma and Kaposi’s sarcoma. Cardiac tamponade, conduction disturbances, non-bacterial thrombotic
endocarditis and sudden death are few other presentations. Zidovudine induced cardiomyopathy should be suspected in a child on treatment with ART and if he develops cardiac symptoms.
Cardiac involvement in HIV infected children is sub-clinical and progressive. Clinical examination, chest radiographs and electrocardiography may pick up manifest cardiac disease. Sub-clinical manifestations such as left ventricular dilatation, hypertrophy and decreased systolic dysfunction can be detected only by
echocardiography.
Yearly echocardiography is advised to pick up the asymptomatic cardiac disease. Treatment with vasodilators, diuretics and inotropic drugs helps in improving the cardiovascular functions.
References
- Shah Ira, Prabhu SS, Sumitra V, Shashikiran HS. Cardiac Dysfunction in HIV Infected Children : A Pilot Study. Indian Pediatrics. 2005;42:146-149.